Case Report

Stevens-Johnson Syndrome (SJS)-Toxic Epidermal Necrolysis (TEN) overlap in a 61-year old woman: a case report

Luh Gede Melia Puspita Sari , Tjok Dalem Pemayun

Luh Gede Melia Puspita Sari
Medical Doctor, Department of Dermatology and Venereology, Wangaya General Hospital, Denpasar, Bali, Indonesia. Email: luhgedemelia@yahoo.co.id

Tjok Dalem Pemayun
Department of Dermatology and Venereology, Wangaya General Hospital, Denpasar, Bali,
Online First: August 01, 2020 | Cite this Article
Sari, L., Pemayun, T. 2020. Stevens-Johnson Syndrome (SJS)-Toxic Epidermal Necrolysis (TEN) overlap in a 61-year old woman: a case report. Intisari Sains Medis 11(2): 606-609. DOI:10.15562/ism.v11i2.618


Background: Epidermal necrolysis (EN) is a rare life-threatening reaction. The exact cause of this disease is unknown. However, the drug is one of the main factors as a cause. EN differentiated based on the extent of skin detachment limited to less than 10% of the body surface area (BSA) in SJS, 10%-30% BSA in SJS/TEN overlap, and greater than 30% of the BSA in TEN. SJS and TEN can occur at various ages, but more often occur at the age of 40 years. Mortality was almost 30% in SJS/TEN overlap patients. Management for SJS and TEN is the cessation of drugs that are thought to be the cause and other supportive therapies.

Case presentation: A 61-year-old female with SJS-TEN overlap, who presented epidermal detachment, is about 10-30% with a positive Nikolsky sign. She had a history of taking medication, such as paracetamol, amoxicillin, and buscopan, before lesion appeared. There were multiple lesions widespread, macula hyperpigmentation multiple, erosion from the bullae that has broken, there also erosion covered by black crust, and various erosions covered with black, brown crusts on lip mucosa and also secret on both eyes. The management of this patient was a cessation of suspected drug and supportive therapy. The patient’s condition was improved within a few weeks, and no sequelae found.

Conclusion: SJS-TEN overlap is one of the epidermal necrolysis in which skin detachment 10-30% BSA. The management was a cessation of all suspected drugs, administering high doses of steroids and other supportive therapies.

References

Dodiuk-Gad RP, Chung WH, Valeyrie-Allanore L, Shear NH. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: An Update. Am J Clin Dermatol. 2015;16(6):475-493.

Mockenhaupt M. The current understanding of Stevens-Johnson syndrome and toxic epidermal necrolysis. Expert Rev Clin Immunol. 2011;7(6):803-815.

Harr T, French LE. Toxic epidermal necrolysis and Stevens-Johnson syndrome. Orphanet J Rare Dis. 2010;5:39.

Mochtar M, Negara WP, Murasmita A. Angka Kejadian Sindrom Stevens-Johnson dan Nekrolisis Epidermal Toksik di RS Dr. Moewardi Surakarta Periode Agustus 2011-Agustus 2013. MDVI. 2015;42(2):65-69.

Yang MS, Lee JY, Kim J, Kim GW, Kim BK, Kim JY, et al. Incidence of Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: A Nationwide Population-Based Study Using National Health Insurance Database in Korea. PLoS One. 2016;11(11):e0165933.

Diphoorn J, Cazzaniga S, Gamba C, Schroeder J, Citterio A, Rivolta AL, et al. Incidence, causative factors and mortality rates of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) in northern Italy: data from the REACT registry. Pharmacoepidemiol Drug Saf. 2016;25(2):196-203.

Seecof OM, Liantonio J. Prognostication Using SCORTEN Severity of Illness Score in Patients With Stevens Johnson Syndrome and Toxic Epidermal Necrolysis. J Pain Symptom Manage. 2019;57(1):e8-e9.

Biswal S, Sahoo SS. Paracetamol induced Stevens-Johnson syndrome--toxic epidermal necrolysis overlap syndrome. Int J Dermatol. 2014;53(8):1042-1044.

Rajput R, Sagari S, Durgavanshi A, Kanwar A. Paracetamol induced Steven-Johnson syndrome: A rare case report. Contemp Clin Dent. 2015;6(Suppl 1):S278-S281.

Romańska-Gocka K, Gocki J, Placek W, Zegarska B, Krause P. Stevens Johnson syndrome after carbamazepine and SJS/TEN overlap syndrome after amoxicillin: case reports and a review. Arch Med Sci. 2010;6(1):130-134.

Diaz MY, Torrijos EG, Lozano LM, Ortega AME, Rodriguez RG, Lopez MCH, et al. Immunoglobulin E-Mediated Severe Allergy to Hyoscine Butylbromide. J Investig Allergol Clin Immunol. 2018;28(4):255-254.

Liu W, Nie X, Zhang L. A retrospective analysis of Stevens-Johnson syndrome/toxic epidermal necrolysis treated with corticosteroids. Int J Dermatol. 2016;55(12):1408-1413.

Law EH, Leung M. Corticosteroids in Stevens-Johnson Syndrome/toxic epidermal necrolysis: current evidence and implications for future research. Ann Pharmacother. 2015;49(3):335-342.

Morita K, Matsui H, Michihata N, Fushimi K, Yasunaga H. Association of Early Systemic Corticosteroid Therapy with Mortality in Patients with Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis: A Retrospective Cohort Study Using a Nationwide Claims Database. Am J Clin Dermatol. 2019;20(4):579-592.

Kardaun SH, Jonkman MF. Dexamethasone pulse therapy for Stevens-Johnson syndrome/toxic epidermal necrolysis. Acta Derm Venereol. 2007;87(2):144-148.

Sudarsa P, Puspawati N, Purnama N, Sanjaya I, Hamid A. Toxic Epidermal Necrolysis (TEN) in an elderly with comorbidities: a case report. Bali Medical Journal. 2020;9(1):323-326.


No Supplementary Material available for this article.
Article Views      : 36
PDF Downloads : 14